Background: Surgery is the treatment for early-stage cervical cancer. Radiochemotherapy is used in the treatment of locally advanced stages. But the choice of treatment can be difficult. Objective: The objective of th...Background: Surgery is the treatment for early-stage cervical cancer. Radiochemotherapy is used in the treatment of locally advanced stages. But the choice of treatment can be difficult. Objective: The objective of this work was to evaluate the therapeutic aspects of cervical cancer in the early stages IA to IIA in the oncology department of A Ledantec Hospital in Dakar. Patients and methods: This was a descriptive retrospective study, from January 2015 to December 2020, in the oncology department of A Ledantec Hospital, including all the patients who had been treated for early-stage invasive cervical cancer. Results: We included 28 patients. The average age was 49.54 years old. There were 11 patients (39.3%) with a stage ≤ IB1. Surgery was the first in 14 patients (50%). The initial approach was a midline supra and subumbilical laparotomy. The surgery was R0 in 65.22%. Postoperative complications were found in 4 patients including 1 case of operative wound suppuration, 1 case of dysuria, 1 case of postoperative eventration and 1 case of rectovaginal fistula. Concomitant Radiochemotherapy was neoadjuvant in 7 cases (25%), adjuvant in 14 cases (50%). The chemotherapy was neoadjuvant in 09 cases (56.25%) and adjuvant in 7 cases (43.75%) with minor toxicities. We had recorded 2 deaths. Conclusion: The treatment of the early stages of invasive cervical cancer is based on surgery. Neoadjuvant treatments may be useful in particular situations.展开更多
The intercostobrachial nerve (ICBN) is responsible for the sensory</span></span></span></span></span><span><span><span><span><span><span style="font-...The intercostobrachial nerve (ICBN) is responsible for the sensory</span></span></span></span></span><span><span><span><span><span><span style="font-family:""><span style="font-family:Verdana;"> innervation of a part of the inner side of the arm. Injury of the intercostobrachial nerve is </span><span style="font-family:Verdana;">a complication of axillary dissection during lymph node dissection.</span> <b><span style="font-family:Verdana;">Objective</span></b><span style="font-family:Verdana;">: </span><span style="font-family:Verdana;">This study aimed to determine the effect of preservation of the</span><span style="font-family:Verdana;"> intercostobra</span><span><span style="font-family:Verdana;">chial nerve on postoperative sensory disturbances. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> This is a</span></span><span style="font-family:Verdana;"> prospective, single-center study which was carried out in 90 patients followed in the oncology department of the Aristide Le Dantec hospital in Dakar, suffering </span><span style="font-family:Verdana;">from breast cancer and having undergone breast surgery associated with</span><span style="font-family:Verdana;"> axillary </span><span style="font-family:Verdana;">dissection, for a period of 6 months. The patients were divided into two</span><span style="font-family:Verdana;"> groups depending on whether the intercostobrachial nerve (ICBN) was preserved or </span><span style="font-family:Verdana;">not. The two groups were compared in terms of the incidence of sensory</span><span style="font-family:Verdana;"> disturbances. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Sixty patients without nerve preservation and 30 patients with nerve preservation were included in the study, </span><i><span style="font-family:Verdana;">i.e.</span></i><span style="font-family:Verdana;">, 90 patients in total. </span><span style="font-family:Verdana;">ICBN was injured in 60 patients of which 41 patients (83.7%) developed</span><span style="font-family:Verdana;"> numbness in the inner arm. While in the preserved group, only 8 patients suffered from numbness (16.3%) with a significant P value of 0.002;however, for </span><span style="font-family:Verdana;">other </span><span style="font-family:Verdana;">variables such as the incidence of neuropathic pain and hypoesthesia-like</span><span style="font-family:Verdana;"> sensory </span><span><span style="font-family:Verdana;">deficit, there was no significant difference. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Preservation of the </span></span><span style="font-family:Verdana;">intercostobrachial nerve during axillary dissection for breast cancer reduces the incidence of sensory disturbances on the upper limb.展开更多
Demo</span><span style="font-family:Verdana;">ns-Meigs syndrome combines a benign tumor of the ovary with thorac</span><span style="font-family:Verdana;">ic and abdominal<...Demo</span><span style="font-family:Verdana;">ns-Meigs syndrome combines a benign tumor of the ovary with thorac</span><span style="font-family:Verdana;">ic and abdominal</span></span><span style="font-family:""> </span><span style="font-family:Verdana;">effusion, it is a rare disease whose pathophysiological mechanism is not yet well understood.</span><span style="font-family:""> </span><span style="font-family:Verdana;">This rare syndrome often gives rise to fear of ovarian neoplasia due to the existence of ascites and the significant elevation of CA 125. In this observation, we report the case of Demons-Meigs syndrome diagnosed in a 36-year-old young woman who presented with pleural and peritoneal effusion syndrome with an</span><span style="font-family:""> </span><span style="font-family:Verdana;">ovarian mass and a CA 125 level = 406.6</span><span style="font-family:""> </span><span style="font-family:Verdana;">IU/ml.</span><span style="font-family:""> </span><span style="font-family:Verdana;">Laparotomy performed revealed very abundant ascites, the uterus and tubes were healthy, no</span><span style="font-family:""> </span><span style="font-family:Verdana;">suspicious peritoneal lesions, the left ovary is healthy, a right ovarian mass of 300 </span><span style="font-family:""><span style="font-family:Verdana;">×</span><span style="font-family:Verdana;"> 150</span></span><span style="font-family:""> </span><span style="font-family:Verdana;">mm.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">A right annexectomy was performed. The operative suites were simple with drying of the</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">effusions. Th</span><span style="font-family:Verdana;">e control CA 125 returned to normal after 6 months of follow-up. A path</span><span style="font-family:Verdana;">ological anatomy result is a fibrothecoma. Demons-Meigs syndrome has a good prognosis;treatment is based on removal of the ovarian tumor.展开更多
<strong>Introduction:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> Cystic breast cancer is a rare entity. Breast cyst...<strong>Introduction:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> Cystic breast cancer is a rare entity. Breast cysts are most often benign. The clinical characteristics of malignancy are not specific. </span><b><span style="font-family:Verdana;">Objective:</span></b> <span style="font-family:Verdana;">To report a series of malignant cystic tumors of the breast and to describe</span><span style="font-family:Verdana;"> their different characteristics. </span><b><span style="font-family:Verdana;">Materials and Methods:</span></b><span style="font-family:Verdana;"> This was an observational study carried out between January 2018 and October 2021 at the Dakar </span><span style="font-family:Verdana;">university surgical oncology unit. We studied the clinical appearance, im</span><span style="font-family:Verdana;">ag</span><span style="font-family:Verdana;">ing, </span><span style="font-family:Verdana;">histopathology, extent of disease and treatment. We did not include cases of</span><span style="font-family:Verdana;"> pure, single, or multiple chronically progressive cysts. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> There were 8 </span><span style="font-family:Verdana;">patients, 6 women and 2 men. The average age was 44. All patients presented </span><span style="font-family:Verdana;">with a palpable unilateral deforming skin mass without inflammatory </span><span style="font-family:Verdana;">character. One patient presented with a bloody discharge. The cyst was</span><span style="font-family:Verdana;"> multilocular with</span><span style="font-family:Verdana;">out intracystic growth in 2 cases and presented a growth signal in 6 cases.</span> <span style="font-family:Verdana;">Imaging was ACR 3 in 5 cases and ACR 4 in 3 cases. Histopathology found 6</span><span style="font-family:Verdana;"> in</span><span style="font-family:Verdana;">va</span><span style="font-family:Verdana;">sive carcinomas including 2 papillary, 3 Invasive Carcinoma of No Special</span><span style="font-family:Verdana;"> Type (ICNST), 1 lobular carcinoma as well as one case of lobular carcinoma </span><i><span style="font-family:Verdana;">in situ</span></i><span style="font-family:Verdana;"> of the comedocarcinoma type in women and 2 ICNST in men. The extension </span><span style="font-family:Verdana;">workup was found in only 1 male patient in the presence of metastases.</span><span style="font-family:Verdana;"> Treatment included chemotherapy, mastectomy and radiotherapy for 6 of </span><span style="font-family:Verdana;">the patients. There wasn’t any complete response for invasive cases. Survival is 100% to date.</span><span> <b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Cystic breast tumors sometimes hide the cancer</span></span><span style="font-family:Verdana;"> that is difficult to diagnose. The prognosis seems favorable, however.</span></span></span></span>展开更多
Myxoid liposarcoma is the most common form of myxoid sarcoma. Their primary and superficial localizations are very rare compared to the deeper forms. We report the case of myxoid liposarcoma in a 57-year-old patient. ...Myxoid liposarcoma is the most common form of myxoid sarcoma. Their primary and superficial localizations are very rare compared to the deeper forms. We report the case of myxoid liposarcoma in a 57-year-old patient. The clinical picture marked by painless swelling of the right thigh had evolved over a period of about ten years. The diagnosis was guided by ultrasound and magnetic resonance imaging. A pathological examination of the surgical specimen after removal of the tumor helped to clarify the diagnosis. We discuss the clinical presentation and therapeutic management.展开更多
<strong>Introduction: </strong>A shoulder mass revealing metastatic prostate cancer is very rare. We report a case of metastatic prostate cancer diagnosed on a shoulder mass and treated with analgesic radi...<strong>Introduction: </strong>A shoulder mass revealing metastatic prostate cancer is very rare. We report a case of metastatic prostate cancer diagnosed on a shoulder mass and treated with analgesic radiotherapy and chemotherapy and androgen deprivation therapy (ADT).<strong> Observations:</strong> A 66 years old patient was referred for a painful right shoulder mass whose biopsy and pathological examination found a Gleason 8 (4 + 4) moderately differentiated adenocarcinoma. The PSA level was 508.52 ng/ml. The patient was treated with analgesic radiotherapy on the right shoulder and chemo-hormonal therapy. At 2 years follow-up, the disease was well controlled. <strong>Conclusion:</strong> A shoulder mass revealing metastatic prostate cancer is not common. Local treatment of the symptomatic metastasis while continuing chemotherapy and ADT improves the quality of life.展开更多
<strong>Background:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> Phylloid sarcomas are rare. There is not enough data...<strong>Background:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> Phylloid sarcomas are rare. There is not enough data to codify the management. </span><b><span style="font-family:Verdana;">Objectives:</span></b><span style="font-family:Verdana;"> The objective was to study the clinical and therapeutic aspects and the fate of patients after a follow-up of at least 4 years. Thus contributing to the limited body of knowledge on these tumors. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> a retrospective analysis of the files from 2013 to 2017 was carried out and patients were followed up until 2021at Hassan II Hospital. Epidemiological, clinical and therapeutic aspects were studied. Survival was calculated using the Kaplan-Meier method. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> We collected 12 charts of patients treated for phyllodeal sarcoma from 2013 to 2017. The median age was 43 years. The circumstance of discovery was marked by the presence of nodule in all patients. The coupled echo-mammography examination classified the nodules, ACR 4 in 7 patients and ACR 3 in 3 and ACR 5 in 2 patients. Histological examination revealed a phylloid sarcoma in 11 patients and a borderline phylloid tumor in 1 patient. All patients had radical surgery with positive margins in 2 patients, 16.66%. One patient had revision surgery. Histological examination of the surgical specimens showed phylloid sarcoma on all specimens. All patients had adjuvant radiotherapy with doses of 50 Gy in 25 fractions of 2 Gy and a boost of 10 Gy was done in one patient. The median spread of radiotherapy was 37 days. Grade 1 and 2 skin toxicities were noted in 5 and 3 patients respectively. The median time from surgery to radiotherapy was 2.95 months. 3 patients relapsed after 13.6 months of follow-up. The recurrence-free survival at 1 and 3 years was 83% and 75% respectively. Overall survival at 3 and 5 years was 83% and 75% respectively. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> This is a rare entity which requires randomized trials to codify its manage</span><span style="font-family:Verdana;">ment. It would seem that the multidisciplinary approach, associating surgery</span><span style="font-family:Verdana;"> ± radiotherapy, is a good option.</span></span></span></span>展开更多
文摘Background: Surgery is the treatment for early-stage cervical cancer. Radiochemotherapy is used in the treatment of locally advanced stages. But the choice of treatment can be difficult. Objective: The objective of this work was to evaluate the therapeutic aspects of cervical cancer in the early stages IA to IIA in the oncology department of A Ledantec Hospital in Dakar. Patients and methods: This was a descriptive retrospective study, from January 2015 to December 2020, in the oncology department of A Ledantec Hospital, including all the patients who had been treated for early-stage invasive cervical cancer. Results: We included 28 patients. The average age was 49.54 years old. There were 11 patients (39.3%) with a stage ≤ IB1. Surgery was the first in 14 patients (50%). The initial approach was a midline supra and subumbilical laparotomy. The surgery was R0 in 65.22%. Postoperative complications were found in 4 patients including 1 case of operative wound suppuration, 1 case of dysuria, 1 case of postoperative eventration and 1 case of rectovaginal fistula. Concomitant Radiochemotherapy was neoadjuvant in 7 cases (25%), adjuvant in 14 cases (50%). The chemotherapy was neoadjuvant in 09 cases (56.25%) and adjuvant in 7 cases (43.75%) with minor toxicities. We had recorded 2 deaths. Conclusion: The treatment of the early stages of invasive cervical cancer is based on surgery. Neoadjuvant treatments may be useful in particular situations.
文摘The intercostobrachial nerve (ICBN) is responsible for the sensory</span></span></span></span></span><span><span><span><span><span><span style="font-family:""><span style="font-family:Verdana;"> innervation of a part of the inner side of the arm. Injury of the intercostobrachial nerve is </span><span style="font-family:Verdana;">a complication of axillary dissection during lymph node dissection.</span> <b><span style="font-family:Verdana;">Objective</span></b><span style="font-family:Verdana;">: </span><span style="font-family:Verdana;">This study aimed to determine the effect of preservation of the</span><span style="font-family:Verdana;"> intercostobra</span><span><span style="font-family:Verdana;">chial nerve on postoperative sensory disturbances. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> This is a</span></span><span style="font-family:Verdana;"> prospective, single-center study which was carried out in 90 patients followed in the oncology department of the Aristide Le Dantec hospital in Dakar, suffering </span><span style="font-family:Verdana;">from breast cancer and having undergone breast surgery associated with</span><span style="font-family:Verdana;"> axillary </span><span style="font-family:Verdana;">dissection, for a period of 6 months. The patients were divided into two</span><span style="font-family:Verdana;"> groups depending on whether the intercostobrachial nerve (ICBN) was preserved or </span><span style="font-family:Verdana;">not. The two groups were compared in terms of the incidence of sensory</span><span style="font-family:Verdana;"> disturbances. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> Sixty patients without nerve preservation and 30 patients with nerve preservation were included in the study, </span><i><span style="font-family:Verdana;">i.e.</span></i><span style="font-family:Verdana;">, 90 patients in total. </span><span style="font-family:Verdana;">ICBN was injured in 60 patients of which 41 patients (83.7%) developed</span><span style="font-family:Verdana;"> numbness in the inner arm. While in the preserved group, only 8 patients suffered from numbness (16.3%) with a significant P value of 0.002;however, for </span><span style="font-family:Verdana;">other </span><span style="font-family:Verdana;">variables such as the incidence of neuropathic pain and hypoesthesia-like</span><span style="font-family:Verdana;"> sensory </span><span><span style="font-family:Verdana;">deficit, there was no significant difference. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Preservation of the </span></span><span style="font-family:Verdana;">intercostobrachial nerve during axillary dissection for breast cancer reduces the incidence of sensory disturbances on the upper limb.
文摘Demo</span><span style="font-family:Verdana;">ns-Meigs syndrome combines a benign tumor of the ovary with thorac</span><span style="font-family:Verdana;">ic and abdominal</span></span><span style="font-family:""> </span><span style="font-family:Verdana;">effusion, it is a rare disease whose pathophysiological mechanism is not yet well understood.</span><span style="font-family:""> </span><span style="font-family:Verdana;">This rare syndrome often gives rise to fear of ovarian neoplasia due to the existence of ascites and the significant elevation of CA 125. In this observation, we report the case of Demons-Meigs syndrome diagnosed in a 36-year-old young woman who presented with pleural and peritoneal effusion syndrome with an</span><span style="font-family:""> </span><span style="font-family:Verdana;">ovarian mass and a CA 125 level = 406.6</span><span style="font-family:""> </span><span style="font-family:Verdana;">IU/ml.</span><span style="font-family:""> </span><span style="font-family:Verdana;">Laparotomy performed revealed very abundant ascites, the uterus and tubes were healthy, no</span><span style="font-family:""> </span><span style="font-family:Verdana;">suspicious peritoneal lesions, the left ovary is healthy, a right ovarian mass of 300 </span><span style="font-family:""><span style="font-family:Verdana;">×</span><span style="font-family:Verdana;"> 150</span></span><span style="font-family:""> </span><span style="font-family:Verdana;">mm.</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">A right annexectomy was performed. The operative suites were simple with drying of the</span><span style="font-family:""> </span><span style="font-family:""><span style="font-family:Verdana;">effusions. Th</span><span style="font-family:Verdana;">e control CA 125 returned to normal after 6 months of follow-up. A path</span><span style="font-family:Verdana;">ological anatomy result is a fibrothecoma. Demons-Meigs syndrome has a good prognosis;treatment is based on removal of the ovarian tumor.
文摘<strong>Introduction:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> Cystic breast cancer is a rare entity. Breast cysts are most often benign. The clinical characteristics of malignancy are not specific. </span><b><span style="font-family:Verdana;">Objective:</span></b> <span style="font-family:Verdana;">To report a series of malignant cystic tumors of the breast and to describe</span><span style="font-family:Verdana;"> their different characteristics. </span><b><span style="font-family:Verdana;">Materials and Methods:</span></b><span style="font-family:Verdana;"> This was an observational study carried out between January 2018 and October 2021 at the Dakar </span><span style="font-family:Verdana;">university surgical oncology unit. We studied the clinical appearance, im</span><span style="font-family:Verdana;">ag</span><span style="font-family:Verdana;">ing, </span><span style="font-family:Verdana;">histopathology, extent of disease and treatment. We did not include cases of</span><span style="font-family:Verdana;"> pure, single, or multiple chronically progressive cysts. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> There were 8 </span><span style="font-family:Verdana;">patients, 6 women and 2 men. The average age was 44. All patients presented </span><span style="font-family:Verdana;">with a palpable unilateral deforming skin mass without inflammatory </span><span style="font-family:Verdana;">character. One patient presented with a bloody discharge. The cyst was</span><span style="font-family:Verdana;"> multilocular with</span><span style="font-family:Verdana;">out intracystic growth in 2 cases and presented a growth signal in 6 cases.</span> <span style="font-family:Verdana;">Imaging was ACR 3 in 5 cases and ACR 4 in 3 cases. Histopathology found 6</span><span style="font-family:Verdana;"> in</span><span style="font-family:Verdana;">va</span><span style="font-family:Verdana;">sive carcinomas including 2 papillary, 3 Invasive Carcinoma of No Special</span><span style="font-family:Verdana;"> Type (ICNST), 1 lobular carcinoma as well as one case of lobular carcinoma </span><i><span style="font-family:Verdana;">in situ</span></i><span style="font-family:Verdana;"> of the comedocarcinoma type in women and 2 ICNST in men. The extension </span><span style="font-family:Verdana;">workup was found in only 1 male patient in the presence of metastases.</span><span style="font-family:Verdana;"> Treatment included chemotherapy, mastectomy and radiotherapy for 6 of </span><span style="font-family:Verdana;">the patients. There wasn’t any complete response for invasive cases. Survival is 100% to date.</span><span> <b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Cystic breast tumors sometimes hide the cancer</span></span><span style="font-family:Verdana;"> that is difficult to diagnose. The prognosis seems favorable, however.</span></span></span></span>
文摘Myxoid liposarcoma is the most common form of myxoid sarcoma. Their primary and superficial localizations are very rare compared to the deeper forms. We report the case of myxoid liposarcoma in a 57-year-old patient. The clinical picture marked by painless swelling of the right thigh had evolved over a period of about ten years. The diagnosis was guided by ultrasound and magnetic resonance imaging. A pathological examination of the surgical specimen after removal of the tumor helped to clarify the diagnosis. We discuss the clinical presentation and therapeutic management.
文摘<strong>Introduction: </strong>A shoulder mass revealing metastatic prostate cancer is very rare. We report a case of metastatic prostate cancer diagnosed on a shoulder mass and treated with analgesic radiotherapy and chemotherapy and androgen deprivation therapy (ADT).<strong> Observations:</strong> A 66 years old patient was referred for a painful right shoulder mass whose biopsy and pathological examination found a Gleason 8 (4 + 4) moderately differentiated adenocarcinoma. The PSA level was 508.52 ng/ml. The patient was treated with analgesic radiotherapy on the right shoulder and chemo-hormonal therapy. At 2 years follow-up, the disease was well controlled. <strong>Conclusion:</strong> A shoulder mass revealing metastatic prostate cancer is not common. Local treatment of the symptomatic metastasis while continuing chemotherapy and ADT improves the quality of life.
文摘<strong>Background:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> Phylloid sarcomas are rare. There is not enough data to codify the management. </span><b><span style="font-family:Verdana;">Objectives:</span></b><span style="font-family:Verdana;"> The objective was to study the clinical and therapeutic aspects and the fate of patients after a follow-up of at least 4 years. Thus contributing to the limited body of knowledge on these tumors. </span><b><span style="font-family:Verdana;">Methods:</span></b><span style="font-family:Verdana;"> a retrospective analysis of the files from 2013 to 2017 was carried out and patients were followed up until 2021at Hassan II Hospital. Epidemiological, clinical and therapeutic aspects were studied. Survival was calculated using the Kaplan-Meier method. </span><b><span style="font-family:Verdana;">Results:</span></b><span style="font-family:Verdana;"> We collected 12 charts of patients treated for phyllodeal sarcoma from 2013 to 2017. The median age was 43 years. The circumstance of discovery was marked by the presence of nodule in all patients. The coupled echo-mammography examination classified the nodules, ACR 4 in 7 patients and ACR 3 in 3 and ACR 5 in 2 patients. Histological examination revealed a phylloid sarcoma in 11 patients and a borderline phylloid tumor in 1 patient. All patients had radical surgery with positive margins in 2 patients, 16.66%. One patient had revision surgery. Histological examination of the surgical specimens showed phylloid sarcoma on all specimens. All patients had adjuvant radiotherapy with doses of 50 Gy in 25 fractions of 2 Gy and a boost of 10 Gy was done in one patient. The median spread of radiotherapy was 37 days. Grade 1 and 2 skin toxicities were noted in 5 and 3 patients respectively. The median time from surgery to radiotherapy was 2.95 months. 3 patients relapsed after 13.6 months of follow-up. The recurrence-free survival at 1 and 3 years was 83% and 75% respectively. Overall survival at 3 and 5 years was 83% and 75% respectively. </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> This is a rare entity which requires randomized trials to codify its manage</span><span style="font-family:Verdana;">ment. It would seem that the multidisciplinary approach, associating surgery</span><span style="font-family:Verdana;"> ± radiotherapy, is a good option.</span></span></span></span>